Describe the known cases in
the literature of epidural hematoma in the parturient.
There are 10 reports in the literature of
neuraxial (spinal or epidural) hematoma occurring in parturients. The cases are
cases: The diagnoses were made clinically and the symptoms resolved
· One case: Magnetic resonance imaging (MRI) was
performed in a patient with neurofibromatosis to make the diagnosis of epidural
hematoma. The symptoms resolved spontaneously.
· One case: Details about the patient were not
available but the patient did require surgery to evacuate an epidural hematoma.
The patient was reported as “still improving”.
cases: Both patients were reportedly healthy but were later found to have a
subdural ependymoma, which is an unpredictable event.
cases: Epidural hematomas were reported in patients who had disorders of
coagulation, both of whom recovered fully or had only minor residual deficits.
One of these patients presented with cholestasis of pregnancy and received
labor epidural analgesia. The patient later developed an epidural hematoma and
was found to have an elevated prothrombin time (PT 27.7 seconds) and partial
thromboplastin time (PTT 59.1 sec-onds). The second woman presented with
preeclampsia and had a history of a lupus anticoagulant. Her preoper-ative
laboratory tests revealed a normal platelet count of 425,000 mm−3, a PT
of 10.5 seconds, and a bleeding time of 3 minutes. Her PTT was elevated at 49
seconds but this was attributed to the lupus anticoagulant. The deci-sion was
made to proceed with an epidural anesthetic for cesarean delivery. However, in
the operating room, the patient had a grand mal seizure after catheter
placement and a general anesthetic was performed. The epidural catheter was
never used. The next day, the patient com-plained of leg weakness and an MRI
showed an epidural hematoma that was subsequently evacuated.
case: A woman with preeclampsia, who had a platelet count of 71,000 mm−3
received an epidural anesthetic with 13 mL of bupivacaine 0.5% for cesarean
delivery. One hour after the procedure, she had a seizure in the postanesthesia
care unit. It was noted that there was no seizure activity in her lower
extremities and a computerized tomography (CT) scan revealed an epidural
collection. A laminec-tomy was performed 6 hours after epidural catheter
placement, at which time 4 mL of blood was drained from the epidural space. The
patient recovered 72 hours later. Whether the 4 mL was sufficient to cause her
symp-toms is unknown; it is possible that the symptoms were related to residual
local anesthetic effects.